高 MELD 评分受者的活体供肝肝移植。

Live donor liver transplantation in high MELD score recipients.

机构信息

Multiorgan Transplant Program, Department of General Surgery, Toronto General Hospital, Toronto, ON.

出版信息

Ann Surg. 2010 Jan;251(1):153-7. doi: 10.1097/SLA.0b013e3181bc9c6a.

DOI:10.1097/SLA.0b013e3181bc9c6a

PMID:19858705

Abstract

BACKGROUND

In 2002, the New York State Committee on Quality Improvement in Living Liver Donation prohibited live liver donation for potential recipients with Model for End-stage Liver Disease (MELD) scores greater than 25. Despite the paucity of evidence to support this recommendation, many centers in North America remain reluctant to offer living donor (LD) to patients with moderate to high MELD scores.

METHODS

We analyzed 271 consecutive adult-to-adult right lobe LD liver transplants performed at our institution between 2002 and 2008 to study the relationship, between recipient MELD scores and the outcome of LD liver transplantation. The recipients were categorized according to their MELD score into a low (Low: <25)and high (Hi: >or=25) MELD group. We compared short-term donor morbidity, graft loss within 30 days, length of hospital stay, biochemical markers of hepatocyte injury and graft function, and 90 day posttransplant complications including infection, rejection, bleeding, and renal failure. Long-term posttransplant outcome was measured by graft and patient survival after 1-, 3-, and 5-years.

RESULTS

Donor and recipient characteristics were similar between groups. Donor outcomes were similar in both groups. Peak recipient aspartat aminotransferase, alanine aminotransferase, and length of hospital stay were similar between both groups. The proportional decrease in postoperative INR and creatinine within the first week was greater in the high versus low MELD score group. High MELD score recipients had more frequent postoperative pneumonia (Low: 2.2% vs. Hi: 14%, P = 0.003), while no differences were observed in rates of biliary complications, rejection, renal failure, or overall infections. Recipients with a MELD <25 versus >or=25 had a similar 1-year (Low: 92% vs. Hi: 83%), 3-year (Low: 86% vs. Hi: 80%), and 5-year (Low: 78% vs. Hi: 80%) graft survival after LD liver transplantation (P = 0.51).

CONCLUSION

LD liver transplantation can provide excellent graft function and survival rates in high MELD score recipients. Thus, when deceased donor organs are scare, a high MELD score alone should not be an absolute contraindication to living liver donation.

摘要

背景

2002 年，纽约州生活供肝捐献质量改进委员会禁止为终末期肝病模型（MELD）评分大于 25 的潜在受者进行活体肝移植。尽管缺乏支持这一建议的证据，但北美的许多中心仍然不愿意为中高危 MELD 评分的患者提供活体供肝（LD）。

方法

我们分析了本机构 2002 年至 2008 年期间进行的 271 例成人至成人右叶 LD 肝移植患者的临床资料，以研究受者 MELD 评分与 LD 肝移植结果之间的关系。受者根据 MELD 评分分为低（低：<25）和高（高：≥25）MELD 组。我们比较了两组患者短期供者发病率、30 天内移植物丢失、住院时间、肝损伤和移植物功能的生化标志物，以及术后 90 天的并发症，包括感染、排斥、出血和肾功能衰竭。移植后 1、3、5 年的移植物和患者存活率来衡量长期移植后结果。

结果

两组间供者和受者的特征相似。两组供者的结局相似。两组间受者的天门冬氨酸转氨酶、丙氨酸转氨酶峰值和住院时间相似。高 MELD 评分组患者术后第 1 周内国际标准化比值和肌酐的下降比例大于低 MELD 评分组。高 MELD 评分组患者术后肺炎发生率较高（低：2.2%比高：14%，P=0.003），但胆道并发症、排斥、肾功能衰竭或总体感染的发生率无差异。MELD<25 与≥25 的患者接受 LD 肝移植后的 1 年（低：92%比高：83%）、3 年（低：86%比高：80%）和 5 年（低：78%比高：80%）的移植物存活率相似（P=0.51）。